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| Value of double-balloon enteroscopy in diagnosis and treatment of obscure lower gastrointestinal bleeding in children |
| ZHANG Zhenqiang ZHOU Yuliang PAN Zhubin JU junjun QI Shiqin |
| Department of Pediatric General Surgery, Anhui Provincial Children’s Hospital, Anhui Province, Hefei 230001, China |
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Abstract Objective To evaluate the value of double-balloon enteroscopy (DBE) in the diagnosis and treatment of obscure lower gastrointestinal bleeding (OGIB) in children. Methods Thirty-one children with OGIB in Anhui Provincial Children’s Hospital from June 2014 to September 2021 were selected. After admission, symptomatic treatment such as hemostasis, blood transfusion, acid inhibition， and fluid replenishment were given as appropriate. The children with negative colonoscopy and imaging examination were selected for DBE examination. The causes and distribution of bleeding in children with OGIB were observed, DBE examination time, laparoscopic operation time, and hospital stay were counted. All children were revisited regularly to observe the treatment effect. Results There were 31 children, including 21 males and 10 females; the average age was (9.13±3.11) years; the average hemoglobin at admission was (86.90±19.31) g/L. The DBE of 26 children was positive, among which 25 patients were confirmed to have Mecker diverticulum (MD) by laparoscopic exploration, and 1 patient was found to have flake mucosal erosion in the intestinal lumen by DBE examination but was negative by laparoscopic exploration; DBE examination was negative in 5 children, and 1 patient with negative DBE examination was confirmed as MD after laparoscopic exploration. The average examination time of DBE was (148.65±44.47) min; the average operation time was (176.58±34.62) min; the average hospital stay was (5.90±1.51) days. No postoperative complications occurred. Postoperative pathology revealed ectopic gastric mucosa in 2 cases. There was no recurrence of lower gastrointestinal bleeding in 26 cases diagnosed with MD and 1 case with negative laparoscopic exploration but positive for DBE. However, in the 4 cases of negative DBE exploration without laparoscopic exploration, one of them showed recurrent hematochezia at 7 months, and the result was still negative after laparoscopic exploration, no gastrointestinal bleeding symptom has occurred again. Conclusion DBE examination is safe, intuitive, and effective. It is suitable for the clinical diagnosis and treatment of MD children with unexplained lower gastrointestinal bleeding as the main manifestation. Combined with laparoscopic exploration, it can effectively complete the minimally invasive treatment of MD.
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